Reduced precision underwrites ego dissolution and therapeutic outcomes under psychedelics

Evidence suggests classic psychedelics reduce the precision of belief updating and enable access to a range of alternate hypotheses that underwrite how we make sense of the world. This process, in the higher cortices, has been postulated to explain the therapeutic efficacy of psychedelics for the treatment of internalising disorders. We argue reduced precision also underpins change to consciousness, known as ‘ego dissolution’, and that alterations to consciousness and attention under psychedelics have a common mechanism of reduced precision of Bayesian belief updating. Evidence connecting the role of serotonergic receptors to large-scale connectivity changes in the cortex suggests the precision of Bayesian belief updating may be a mechanism to modify and investigate consciousness and attention.

Comorbidity Between Internalising and Externalising Disorders Among Adolescents: Symptom Connectivity Features and Psychosocial Outcome

Internalising disorders are highly prevalent conditions in adolescence and tend to co-occur with externalising disorders. The present study used a symptom network approach to examine the interplay between symptoms of internalising disorders among adolescents with comorbid internalising and externalising disorders. Data comes from the National Comorbidity Survey—Adolescent Supplement, a nationally representative survey of adolescents aged 13 to 18 years. The most central symptoms across the disorders in the network were poor self-esteem and worry. The comorbidity between anxiety and depression increases the probability of having comorbid externalising disorders. Adolescents with both internalising and externalising disorders had the highest rate of health service utilisation. Comorbidity group, lifestyle factors, deficits in cognitive and academic competence and coping skills were significant covariates of the mental health outcomes. Understanding comorbidity profile of internalising and externalising disorders and central symptoms that bridge these disorders could have important clinical implications.

Mental health and suicidal ideation in US military veterans with histories of COVID-19 infection

IntroductionThere have been reports of increased prevalence in psychiatric conditions in non-veteran survivors of COVID-19. To date, however, no known study has examined the prevalence, risk and protective factors of psychiatric conditions among US military veterans who survived COVID-19.MethodsData were analysed from the 2019 to 2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative, prospective cohort of 3078 US veterans. Prepandemic and 1-year peripandemic risk and protective factors associated with positive screens for peripandemic internalising (major depressive, generalised anxiety and/or posttraumatic stress disorders) and externalising psychiatric disorders (alcohol and/or drug use disorders) and suicidal ideation were examined using bivariate and multivariate logistic regression analyses.ResultsA total of 233 veterans (8.6%) reported having been infected with COVID-19. Relative to veterans who were not infected, veterans who were infected were more likely to screen positive for internalising disorders (20.5% vs 13.9%, p=0.005), externalising disorders (23.2% vs 14.8%, p=0.001) and current suicidal ideation (12.0% vs 7.6%, p=0.015) at peripandemic. Multivariable analyses revealed that greater prepandemic psychiatric symptom severity and COVID-related stressors were the strongest independent predictors of peripandemic internalising disorders, while prepandemic trauma burden was protective. Prepandemic suicidal ideation, greater loneliness and lower household income were the strongest independent predictors of peripandemic suicidal ideation, whereas prepandemic community integration was protective.ConclusionPsychiatric symptoms and suicidal ideation are prevalent in veterans who have survived COVID-19. Veterans with greater prepandemic psychiatric and substance use problems, COVID-related stressors and fewer psychosocial resources may be at increased risk of these outcomes.

Overlap between attention-deficit hyperactivity disorder and neurodevelopmental, externalising and internalising disorders: separating unique from general psychopathology effects

BackgroundAlthough attention-deficit hyperactivity disorder (ADHD) is classified as a neurodevelopmental disorder in the latest diagnostic manuals, it shows phenotypic and genetic associations of similar magnitudes across neurodevelopmental, externalising and internalising disorders.AimsTo investigate if ADHD is aetiologically more closely related to neurodevelopmental than externalising or internalising disorder clusters, after accounting for a general psychopathology factor.MethodFull and maternal half-sibling pairs (N = 774 416), born between 1980 and 1995, were identified from the Swedish Medical Birth and Multi-Generation Registers, and ICD diagnoses were obtained from the Swedish National Patient Register. A higher-order confirmatory factor analytic model was fitted to examine associations between ADHD and a general psychopathology factor, as well as a neurodevelopmental, externalising and internalising subfactor. Quantitative genetic modelling was performed to estimate the extent to which genetic, shared and non-shared environmental effects influenced the associations with ADHD.ResultsADHD was significantly and strongly associated with all three factors (r = 0.67–0.75). However, after controlling for a general psychopathology factor, only the association between ADHD and the neurodevelopmental-specific factor remained moderately strong (r = 0.43, 95% CI = 0.42–0.45) and was almost entirely influenced by genetic effects. In contrast, the association between ADHD and the externalising-specific factor was smaller (r = 0.25, 95% CI = 0.24–0.27), and largely influenced by non-shared environmental effects. There remained no internalising-specific factor after accounting for a general factor.ConclusionsFindings suggest that ADHD comorbidity is largely explained by genetically influenced general psychopathology, but the strong link between ADHD and other neurodevelopmental disorders is also substantially driven by unique genetic influences.

Alcohol consumption and internalising disorders in young adults of ALSPAC: a population-based study

IntroductionDepression and harmful alcohol consumption contribute significantly to the global health burden, but in young adults, this relationship is under-researched and conflicted. The aim of this study was to determine the sex-based prevalence and the association between internalising disorders such as depression and alcohol use disorders.MethodUsing the Avon Longitudinal Study of Parents and Children, we assessed the sex-specific prevalence of International Classification of Diseases,Tenth Revision diagnosed generalised anxiety disorder (GAD), depression and fear-based anxieties (FBA) at 24 years (n=3572). We examined the association between internalising disorders and alcohol consumption using the Alcohol Use Disorder Identification Test for Consumption 5+ threshold and Diagnostic and Statistical Manual on Mental Disorders defined criteria for alcohol dependence.ResultsWomen reported more GAD (11.6% vs 6.5%), depression (13.4% vs 6.9%) and FBA (1.3% vs 0.5%) than men (p<0.001). Harmful drinking, after adjustment for sex and socioeconomic status, was associated with a higher prevalence of depression (OR 1.8, 95% CI 1.3 to 2.4, p<0.001), anxiety (OR 1.4, 95% CI 1.0 to 2.0, p<0.001) and FBA (OR 2.4, 95% CI 1.04 to 5.56, p=0.009) compared with lower-risk drinkers. In contrast, hazardous drinking was associated with a lower prevalence of GAD (OR 0.69, 95% CI 0.54 to 0.88) and depression (OR 0.68, 95% CI 0.54 to 0.86) compared with lower-risk drinkers.ConclusionsYoung adults in the UK who drink harmfully are more likely to have depression and other internalising disorders. Further research should test whether there is a J-shaped relationship between alcohol consumption and mental health in young people and whether this varies across the life course.

Association of childhood maltreatment with internalising and externalising disorders in trauma-exposed adolescents

Introduction: South African adolescents experience high levels of trauma, including various types of childhood maltreatment. Different types of maltreatment often co-occur. Previous research suggests that childhood maltreatment provokes a latent liability to internalising and externalising dimensions of psychopathology. Our objective was to examine the effects of childhood maltreatment on internalising and externalising disorders in trauma-exposed adolescents and to assess the mediating effect of post-traumatic stress disorder (PTSD) on these associations.Methods: A cross-sectional study was conducted with 262 trauma exposed adolescents (aged 12–18 years) in South Africa. Childhood maltreatment and PTSD severity were assessed using the Childhood Trauma Questionnaire and the Child PTSD Checklist, respectively. Psychiatric disorders were diagnosed utilising the Kiddie Schedule for Affective Disorders and Schizophrenia – Present and Lifetime version – and were grouped into internalising and externalising disorders. Hierarchal logistic regression was used to assess the association between childhood maltreatment types and internalising and externalising disorders, controlling for statistically significant socio-demographic characteristics, with PTSD severity added to the final model as a potential mediator.Results: Sexual abuse was significantly associated with internalising disorders (B = 0.07, p = 0.011), although this effect was mediated by PTSD severity (B = 0.05, p = 0.001; not included as an internalising disorder). In contrast, physical abuse (B = 0.09, p = 0.004) and gender (B = 0.70, p = 0.035) were associated with externalising disorders, but the addition of PTSD severity did not significantly alter these associations.Conclusion: The association between sexual abuse and internalising disorders was fully mediated by PTSD symptom severity. Gender and physical abuse severity, but not PTSD severity, was associated with the presence of externalising disorders. Adolescents displaying internalising or externalising psychopathology need to be assessed for exposure to childhood physical and sexual abuse and PTSD comorbidity.

Primary healthcare utilisation among adults with mood and anxiety disorders: an analysis of the New Zealand Health Survey

ABSTRACT INTRODUCTION In New Zealand, as in other OECD countries, there is a high and growing prevalence of mental health problems, particularly anxiety and depression. These conditions are associated with a range of physical illnesses, and as a result this population have high and often complex needs for healthcare services, particularly through primary care. AIM To use data from the New Zealand Health Survey (NZHS) to examine the associations between internalising disorders (including anxiety, depression and bipolar disorder) and measures related to the utilisation of primary healthcare services. METHODS The study was based on responses from 13,719 adults who took part in the 2015–16 NZHS. Logistic regression analyses adjusted for sociodemographic variables were undertaken to examine the effect of having an internalising disorder on each measure related to primary healthcare utilisation. The strength of associations was indicated by odds ratios (ORs). RESULTS Adults with an internalising disorder were more likely to utilise primary health services (OR = 1.43–2.56, P < 0.001) compared to adults without an internalising disorder. However, they were more likely to have unmet needs due to cost or transport (OR = 2.45–3.38, P < 0.001), unfilled prescriptions due to cost (OR = 3.03, P < 0.001) and less likely to report positive experiences with general practitioners (OR = 0.67–0.79, P < 0.01). DISCUSSION Adults with internalising disorders require a higher level of support from primary healthcare, yet experience more barriers to accessing these services, and report less positive experiences with general practitioners. The NZHS may be a useful source of routinely collected data for understanding, monitoring and improving primary health service utilisation among people with internalising disorders.